Augment insert, shoulder prosthesis and kit comprising the augment insert

ABSTRACT

This augment insert (200), comprises a coupling member (204) for securing the augment insert to a glenoid component (103) of a shoulder prosthesis (101), and a body (202), comprising a first side (206), configured to bear against a scapular side (107) of the glenoid component when the augment insert is secured to the glenoid component by means of the coupling member; and a second side, opposed to the first side and configured to bear against or be adjacent to a scapula of a patient. According to the invention, the body (202) comprises at least one breakable portion (230), extending from the first side (206) to the second side and configured to be broken off the body. The aperture (234) is provided for accommodating an engaging member (111) of the glenoid component (103), said engaging member protruding from a scapular surface (127) of the scapular side (107) of the glenoid component (103) and being configured for securing the shoulder prosthesis to the scapula.

Any and all applications for which a foreign or domestic priority claimis identified in the Application Data Sheet as filed with the presentapplication are hereby incorporated by reference under 37 C.F.R. § 1.57.

The invention concerns an augment insert, a shoulder prosthesiscomprising such an augment insert, a kit comprising such an augmentinsert and a method of using such an augment insert.

The invention relates to the domain of shoulder arthroplasty, preferablyfor a human patient, alternatively for an animal patient.

A natural shoulder joint comprises a glenoid cavity of concave shape,formed on a scapula of the patient and a humeral head of convex shape,formed at an end of the humerus of the patient. Arthrosis or the like,implying a worn shoulder joint, may require replacement of the shoulderjoint of a patient by a shoulder prosthesis through surgery.

Known shoulder prosthesis comprise a glenoid component, configured to beimplanted in the glenoid cavity, and a humeral component, configured tobe implanted at the humeral head.

Anatomic shoulder prosthesis are known, characterized by a glenoidcomponent of concave shape, cooperating with a humeral component ofconvex shape, alike a natural shoulder joint. Generally, the glenoidcomponent of anatomic shoulder prosthesis requires few implantationmeans, typically only one stem, for implantation in the scapula of thepatient. For example, this stem is of porous structure for osseouscolonization, which is sufficient for fixing and maintaining the glenoidcomponent.

Reverse shoulder prosthesis are also known, characterized by a glenoidcomponent of convex shape, cooperating with a humeral component ofconcave shape, contrary to a natural shoulder joint. Due to thegeometrical configuration of the reverse shoulder prosthesis, includingshifted rotation center, the mechanical stress exerted onto the glenoidcomponent is more important than for the anatomic shoulder prosthesis.Thus, it is usually required to provide stronger implantation means,typically several screws, for a reliable fixation of the glenoidcomponent to the scapula of the patient.

Reverse and anatomic shoulder prosthesis may be adapted respectively todifferent cases specific to the patient.

In some particular cases, the wear does not regularly affect thepatient's glenoid cavity, but is rather centered on superior and/orposterior side thereof. To the contrary, some cases display a moredistributed wear of the glenoid cavity. Thus, it is often required toadapt the shape of the glenoid component to the shape of the wornglenoid cavity of the patient.

This may be done by adding cement of bone graft for compensating theshape differences of the glenoid component relative to the patient'sbone. However, in some cases, cement or bone graft are not thick enoughor do not allow correct and reliable integration of the glenoidcomponent to the patient's bone.

This may also be done by providing glenoid components of differentshapes, optionally in combination with cement or bone graft. However,providing many glenoid components of different types raise economic andpractical problems. In particular, insofar as for a given patient, thesurgeon needs to choose the reversed or anatomic glenoid implant whichis the most suitable to the patient in terms of size and geometry,glenoid components of various size and geometry need to be available tothe surgeon, which induces substantial inventory constraints.

US 2016/0045323 A1 discloses modular reverse and anatomic shoulderglenoid components that may be provided with an augment insert formodifying the shape of part of the component in contact with thescapular bone.

However, most of the anatomic and reverse glenoid components differ inthat stems or screws are distributed at different locations at theirscapular side, or due to a different shape of scapular surface.Consequently, two different sets of augment inserts are usuallyprovided, each adapted respectively to the anatomic and to the reverseglenoid components.

One of the goals of the present invention is to overcome at least someof the aforementioned problems, especially the constraints related toinventories of the various pieces used to provide a modular shoulderprosthesis.

To this end, the invention concerns:

An augment insert, comprising:

-   -   a coupling member for securing the augment insert to a glenoid        component of a shoulder prosthesis, and    -   a body, comprising:        -   a first side, configured to bear against a scapular side of            the glenoid component when the augment insert is secured to            the glenoid component by means of the coupling member;        -   a second side, opposed to the first side and configured to            bear against or be adjacent to a scapula of a patient; and        -   at least one breakable portion, extending from the first            side to the second side and configured to be broken off the            body, wherein when the breakable portion is broken off the            body, an aperture is opened through the body, said aperture            extending from the first side to the second side.

Thanks to the invention, the breakable portion may be broken off or not,depending if the augment insert should be secured to a glenoid componentwith a scapular side of a first shape or with a scapular side of asecond shape, different from the first shape. Thus, a single augmentinsert is suitable for two different types of glenoid components. Morespecifically, a single augment insert may be adapted in situ to theshape of the glenoid component to be secured to, by choosing whether tobreak off the breakable portion. Thereby, the number of availableaugment inserts in inventory can be reduced. In particular, when theaugment insert is to be secured to a glenoid component of which scapularside comprises a specific engaging member, the aperture may provide freespace for accommodating this engaging member. Thus, said engaging membermay extend through the aperture of the augment insert, when the augmentinsert is secured to such a glenoid component.

Further advantageous and optional features of the invention are definedbelow:

-   -   the aperture is provided for accommodating an engaging member of        the glenoid component, said engaging member protruding from a        scapular surface of the scapular side of the glenoid component        and being configured for securing the shoulder prosthesis to the        scapula;    -   the body comprises a pre-cut outline, the pre-cut outline        delimiting the breakable portion, and forming an aperture edge        of the aperture when the breakable portion is broken off the        body;    -   the body comprises a peripheral edge delimiting the first side        and the second side, the peripheral edge comprises a thinner        radial edge portion and a thicker labrum edge portion, and the        breakable portion is provided at the radial edge portion;    -   the augment insert is at least partially made of a material with        a lattice structure;    -   the augment insert is made from additive manufacturing;    -   the first side is of smoother surface and the second side is of        rougher surface.

The invention also concerns:

A shoulder prosthesis, comprising:

-   -   an augment insert as defined above, and    -   a glenoid component, comprising a scapular side to which the        augment insert is secured by the coupling member of the augment        insert.

Further advantageous and optional features of the invention are definedbelow:

-   -   the glenoid component comprises an articular side opposed to the        scapular side, the articular side having a convex articular        surface;    -   the glenoid component comprises an articular side opposed to the        scapular side, the articular side having a concave articular        surface.

The invention also concerns:

A kit, comprising:

-   -   a first glenoid component, comprising a scapular side,    -   a second glenoid component, comprising a scapular side which is        shaped differently from the scapular side of the first glenoid        component,    -   an augment insert as defined below, the augment insert being:        -   shape-compatible for bearing against the scapular side of            the first glenoid component and shape-incompatible for            bearing against the scapular side of the second glenoid            component, when the breakable portion is not broken off the            body, and        -   shape-compatible for bearing against the scapular side of            the second glenoid component, when the breakable portion is            broken off the body.

Further advantageous and optional features of the invention are definedbelow:

-   -   the breakable portion has a surface, which extends at the first        side of the body when the breakable portion is not broken off,        and which is shaped to match a scapular surface of the scapular        side of the first glenoid component when the first side bears        against said scapular side, and when the breakable portion is        broken off the body, an aperture is opened through the body,        said aperture extending from the first side to the second side,        the aperture being positioned for accommodating a first engaging        member of the scapular side of the second glenoid component;    -   the scapular side of the first glenoid component comprises a        second engaging member, the scapular side of the second glenoid        component comprises a third engaging member, the coupling member        of the augment insert is configured for securing indifferently:        the second engaging member, when the first side bears against        the scapular side of the first glenoid component, and the third        engaging member, when the first side bears against the scapular        side of the second glenoid component.    -   the scapular side of the first glenoid component comprises a        fourth engaging member, the scapular side of the second glenoid        component comprises a fifth engaging member, and the body being        provided with a first through-opening or first cut-away portion        for accommodating the fourth engaging member when the first side        bears against the scapular side of the first glenoid component        and a second through-opening or second cut-away portion for        accommodating the fifth engaging member when the first side        bears against the scapular side of the second glenoid component.    -   the first glenoid component comprises an articular side opposed        to the scapular side and comprising a convex articular surface,        and the second glenoid component comprises an articular side        opposed to the scapular side and comprising a concave articular        surface.

The invention also concerns: A method of using the augment insertaccording to claim 1, for forming a shoulder prosthesis, the methodcomprising the following steps:

-   -   Step A): choosing if the augment insert should be secured to:        -   choice A1): a first glenoid component comprising a first            scapular side, or        -   choice A2): a second glenoid component comprising a second            scapular side;    -   if choice A1) is chosen at Step A):        -   Step B1): not breaking off the breakable portion, and        -   Step C1): securing the augment insert to the first scapular            side of the first glenoid component by means of the coupling            member of the augment insert, for obtaining that the            shoulder prosthesis comprises the first glenoid component            and the augment insert, secured to the first scapular side            of the first glenoid component by the coupling member of the            augment insert;    -   if choice A2) is chosen during at Step A):        -   Step B2): breaking off the breakable portion, and        -   Step C2): securing the augment insert to the second scapular            side of the second glenoid component by means of the            coupling member of the augment insert, for obtaining that            the shoulder prosthesis, comprises the second glenoid            component and the augment insert, secured to the second            scapular side of the second glenoid component by the            coupling member of the augment insert.

Further advantageous and optional features of the invention are definedbelow:

According to an embodiment, steps A), as well as steps B1) and C1) orB2) and C2) are performed in-situ by a surgeon or one of his assistants,for example in an operating room of a medical facility.

Step A) is performed depending on the specific medical case of thepatient, in particular of the specific shoulder pathology of thepatient.

Steps A), B1) and C1), or steps A), B2) and C2), are performed beforethe surgeon performs a step D) of implanting the shoulder prosthesis inthe patient.

Step D) includes implanting the prosthesis in the patient, by securingsaid prosthesis to the scapula of the patient. In a preferredembodiment, engaging members of the prosthesis are engaged into thescapula of the patient for securing the prosthesis to the scapula of thepatient. When the prosthesis is implanted in the patient, the augmentinsert is interposed between the scapula of the patient and the glenoidcomponent of the prosthesis. When the prosthesis is implanted in thepatient, the second side of the augment insert bears against the scapulaof the patient or is at least adjacent thereto. Preferably, when theprosthesis is implanted in the patient a part of the scapular side bearsagainst the scapula of the patient.

Since the augment insert is secured to the glenoid component before stepD), the risk of separating or misplacing the augment insert is reduced.

Steps A), as well as steps B1) and C1) or B2) and C2) may be performedbefore or after the surgeon performs a step E) of opening the patient.

If choice A1) is chosen at step A), and optionally if steps B1) and C1)have already been performed, the surgeon may afterwards prefer choiceA2), and perform the following steps:

-   -   Step F): separating the augment insert from the first glenoid        component,    -   Step B2), and    -   Step C2).

The method also comprises a step G) of closing the patient, for exampleby stitching up, after step D) is performed.

According to another embodiment, one or all the steps A), B1), C1), B2)and C2) may be performed by a person unqualified for surgery. Forexample, these steps may be performed for preparing several prosthesisof different type in advance, for a later surgical usage by one or moresurgeons. The choice of which prosthesis is to be used for a specificpatient is then made by said surgeon.

Preferably, the person unqualified for surgery belongs to personnel incharge of the inventory of a medical facility, in particular a facilitywhere the surgeon is intended to implement the prosthesis in thepatient.

Alternatively, the person unqualified for surgery belongs to personnelin charge of the manufacturing or the assembling of the prosthesis, in amanufacturing facility or factory separate from the abovementionedmedical facility.

The invention is explained through illustrative and non-limitativeexamples described below and illustrated by the annexed figures where:

FIGS. 1 and 2 are exploded perspective views of a shoulder prosthesisaccording a first embodiment of the invention;

FIG. 3 is an assembled perspective view of the shoulder prosthesis ofFIGS. 1 and 2;

FIG. 4 is a side view of the shoulder prosthesis of FIGS. 1 to 3;

FIG. 5 is a perspective view of the shoulder prosthesis of FIGS. 1 to 4,mounted onto a scapula of a patient;

FIGS. 6 and 7 are exploded perspective views of a shoulder prosthesisaccording a second embodiment of the invention;

FIG. 8 is an assembled perspective view of the shoulder prosthesis ofFIGS. 6 and 7;

FIG. 9 is a side view of the shoulder prosthesis of FIGS. 6 to 8;

FIG. 10 is a perspective view of the shoulder prosthesis of FIGS. 6 to9, mounted onto a scapula of a patient;

FIG. 11 is a perspective view of an augment insert belonging to bothshoulder prosthesis of FIGS. 1 to 10;

FIG. 12 is an exploded perspective view of a shoulder prosthesisaccording to a third embodiment of the invention;

FIG. 13 is an assembled perspective view of the shoulder prosthesis ofFIG. 12; and

FIG. 14 is a perspective view of an augment insert belonging to theshoulder prosthesis of FIGS. 12 and 13.

Referring to FIGS. 1 to 5, a shoulder prosthesis 1 is shown in.Referring to FIGS. 6 to 10, a shoulder prosthesis 101 is shown in. Theshoulder prosthesis 1 and 101 include an augment insert 200, illustratedalone on FIG. 11. The same augment insert 200 is used for both shoulderprosthesis 1 and 101. The shoulder prosthesis 1 and 101 respectivelyinclude a glenoid component 3 and a glenoid component 103, which aredifferent from each other, as described below.

As shown respectively on FIGS. 5 and 10, both shoulder prosthesis 1 and101 are configured for being implanted respectively in a scapula 5 and ascapula 105 of human patients, at the glenoid cavity thereof. In bothcases, the augment insert 200 is introduced between the concernedglenoid component 3 or 103 and the concerned scapula 5 or 105, foradapting to the patient specific shape of the scapula 5 and 105.Depending on the shape of the scapula of the patient, an augment insertof different shape and/or thickness than the augment insert 200, may bechosen to adapt or compensate for said shape. The augment insert 200 isused as a leveling spacer of predetermined thickness, for modularadaptation of the shape of the shoulder prosthesis 1 or 101 specificallya patient's scapula.

The shoulder prosthesis 1 and 101 illustrated on FIGS. 1 to 11 areconfigured for a left shoulder. Symmetrical features may be applied fora right shoulder.

As shown on FIGS. 1 to 11, the augment insert 200, mainly comprises abody 202, having the abovementioned levelling function, and a couplingmember 204, for securing the augment insert 200 to one of the glenoidcomponents 3 and 103.

The body 202 comprises two opposed sides 206 and 208, each comprising aslightly curved surface. Alternatively, one or both sides 206 and 208define a flat surface. In the present example, each side 206 and 208 isgenerally shaped as a crescent, so that the augment insert 200 coversonly a portion of the glenoid cavity of the patient, corresponding toapproximately a half of the glenoid cavity.

When the augment insert 200 is secured onto the glenoid component 3 or103, the side 206 bears against a scapular side 7 or a scapular side 107of the concerned glenoid component 3 or 103. The side 206 may match ormirror the geometry of the scapular sides 7 and 107 as explained below.

When the prosthesis 1 or 101 is implemented in the patient, the side 208bears against or is adjacent to the glenoid cavity of the scapula 5 or105. The augment insert 200 is chosen so that the geometry of the side208 substantially matches or mirrors the geometry of the glenoid cavityof the scapula 5 or 105. Optionally, the side 208 can be made patientspecific, which means that the side 208 can be manufactured specificallyfor a predetermined patient, based on the geometry or features specificto this patient. In brief, a scan such as computed tomography (CT) ormagnetic resonance imaging (MRI) is performed of a specific patientanatomy, and a portion of the implant, such as side 208, is shapedspecifically to accommodate the patient's anatomy.

The aforementioned “shape and/or thickness” of the augment insert 200 isdefined by geometrical features of the sides 206 and 208. Augmentinserts of different shape and/or thickness than the illustrated augmentinsert 200 include for example a different distance or length betweenthe sides 206 and 208 and/or a different relative inclination and/or adifferent geometry of one or both sides 206 and 208.

The body 202 also comprises a peripheral edge 210 delimiting and linkingboth sides 206 and 208. The edge 210 is defined all around the body 202and connects sides 206 and 208. The peripheral edge 210 defines asurface oriented approximately perpendicularly to the sides 206 and 208.

As best visible on FIG. 4, preferably, the side 206 is inclined relativeto the side 208. In other words, side 206 is not parallel to side 208,so that the body 202 is shaped as a wedge.

The edge 210 comprises a radial edge portion 211 and a labrum edgeportion 212 opposed to each other. The radial portion 211 is thinnerthan the labrum portion 212. The thickness of the portions 211 and 212is to be measured from side 206 to side 208. The side 206 and the side208 form an angle originating from the radial edge portion 211

The labrum edge portion 212 is intended to be extending along a portionof the glenoid labrum (i.e. the peripheral rim of the glenoid cavity) ofthe scapula 5 or 105 of the patient when the shoulder prosthesis 1 or101 is implemented. As best visible on FIG. 1, the labrum edge portion212 comprises a substantially flat median surface 214 and two extremalsurfaces 215 and 216 extending therefrom, the two surfaces 215 and 216being strongly curved towards a similar direction.

The radial edge portion 211 is intended to extend across the glenoidcavity of the scapula 5 or 105 of the patient when the shoulderprosthesis 1 or 101 is implemented. In other words, the edge portion 211may extend along a diameter or a chord of the labrum, along the concavesurface of the glenoid cavity. The radial edge portion 211 is slightlycurved for corresponding to the concave shape of the glenoid cavity. Theportion 211 extends substantially parallel to the median surface 214 ofthe body 202. The radial edge portion 211 links the surface 215 to thesurface 216 of the labrum edge portion 212. The radial edge portion 211and the labrum edge portion 212 meet at two opposed corners 217 and 218of the edge 210.

As a summary, in the illustrated example, the edge 210 comprises theradial edge portion 211 and the labrum edge portion 212. The radial edgeportion 211 and the labrum edge portion 212 are connected at the corners217 and 218. The labrum edge portion 212 comprises three surfaces 215,214 and 216, linking corner 217 to corner 218. The detail III of FIG. 3illustrates only the edge 210 along with its features as describedabove.

Turning to the glenoid component 3 depicted on FIGS. 1 to 5, it may beseen that said glenoid component 3 comprises a main body 22, includingthe abovementioned scapular side 7 and an opposed articular side 20.

As visible on FIGS. 2 and 3, the scapular side 7 comprises a slightlycurved scapular surface 27, which shape or geometry corresponds to theside 206 of the augment insert 200. This allows the side 206 of theaugment insert 200 to bear against side 7. More specifically, thesurface of side 206 is designed to be completely, or at least partially,in contact with the scapular surface 27, when the augment insert issecured to the glenoid component. Scapular surface 27 is partiallycovered by surface 206. The bone contact is shared between scapularsurface 27 and augment insert surface 202.

The scapular side 7 of the glenoid component 3 has a peripheral edge 4delimiting the scapular surface 27 of the side 7. As visible on FIGS. 3and 4, the labrum edge portion 212 and a portion of the edge 4 are putin correspondence when the insert 200 is secured to the glenoidcomponent 3. In other words, the labrum edge portion 212 matches withthe edge 4 along a portion thereof. More visibly on FIG. 4, therespective peripheral surfaces of the labrum edge portion 212 and of theedge 4 are arranged continuously when the insert 200 is secured to theglenoid component 3.

More generally, the peripheral edge 4 has a generally elliptical shapecorresponding to the shape of the rim of the glenoid cavity of thescapula 5 of the patient.

When the augment insert 200 is secured to the glenoid component 3, onlya portion of the scapular surface 27 is covered by said augment insert200. Thus, a portion of the surface 27 remains uncovered and may bearagainst glenoid cavity of the scapula 5 of the patient, when theshoulder prosthesis 1 is implemented in the patient. In the presentexample, the portion of the scapular side 7 covered by the augmentinsert 200 is a posterior portion of the scapular side 7, while theanterior portion is left uncovered. Thus, a posterior levellingcorrection is applied. In other words, the augment insert 200 correctsthe orientation of the glenoid component 3, by interposing between theglenoid component 3 and the glenoid cavity of the scapula 5 at aposterior area thereof. Alternatively, the augment insert 200 may beconfigured so that another portion of the scapular side 7 is covered,such as an upper portion, for applying an upper levelling correction. Inthis case, the augment insert 200 corrects the orientation of theglenoid component 3, by interposing between the glenoid component 3 andthe glenoid cavity of the scapula 5 at an upper area thereof.Alternatively, the body 202 may be shaped for covering the entirescapular surface 27. The correction to be applied depends on the shapeof the glenoid cavity onto which the shoulder prosthesis 1 is to beimplanted.

Preferably, the side 206 is of smoother surface and the side 208 is ofrougher surface. This rougher surface may be obtained by coating, sandblasting, hydroxyapatite (HAP) deposit, formation of a macro structure,or any other method depending on the application. Thus, when theprosthesis 1 or 101 is implemented, the rougher surface of the side 208promotes osseous colonization or adhesion of the side 208 by thepatient's bone. The side 206 having a smoother surface, it is lessprompt to wearing the side 7 or 107 of the respective glenoid component3 or 103 in contact.

More generally, the body 202 is configured to resist compressive stressexerted on the side 206 by the chosen glenoid component 3 or 103 and onthe side 208 by the scapula 5 or 105 of the patient.

Preferably, at least the body 202 of the augment insert 200 is oflattice structure. By “lattice structure”, it is understood that thebody 202 is made of a material with a porous geometry configured forpromoting osseous colonization and/or body fluid impregnation.Alternatively, the entire augment insert 200 may be made of suchmaterial. Alternatively, only a part of the augment insert 200 may bemade of such material, including at least one of the sides 206 or 208. Anon-porous geometry may be chosen for all or a part of the body 202,instead of the abovementioned lattice structure, depending on theapplication.

The augment insert may be made of a metal, such as titanium, or anyother metal depending on the application. Another suitable material maybe chosen instead of metal, depending on the application, for example aceramic material or a thermoplastic material such as Polyethylene (PET)or polyetheretherketone (PEEK). Alternately, a ceramic such aspyrocarbon may be employed. Any other suitable material may be useddepending on the case.

Preferably, at least the body 202 of the augment insert 200 is made fromadditive manufacturing, preferably direct metal laser sintering. Thisallows in particular making the side 208 patient specific. Morepreferably, the entire augment insert 200 is made from additivemanufacturing. Alternatively, manufacturing the augment insert 200includes a step of molding or connecting at least the body 202, or thebody 202 and the coupling member 204.

Preferably, the coupling member 204 is integral with the body 202.Alternatively, the coupling member 204 may be a separate part from thebody 202, which are permanently assembled together during manufacturingof the augment insert 200, or at a later stage.

As visible on FIGS. 2 to 4, the scapular side 7 of the glenoid component3 comprises three engaging members 8, 9 and 10, protruding from thescapular surface 27. On the figures, the two engaging members 8 and 10are respectively illustrated symbolically by two axis lines, whereas theengaging member 9 is illustrated realistically.

By “engaging member”, it is understood any suitable member for securinga shoulder prosthesis to the scapular bone of the patient. Depending onthe application, an engaging member may include a screw, a stem, ananchor or the like.

The engaging member 9 is protruding from a central location of thesurface 27. A central location of the member 9 on side 7 is preferred,for a better stability of the implantation of the glenoid component 3.

In the present example, said member 9 comprises a frustoconical tubularbody 12 protruding from the surface 27 along an axis X9, generallyorthogonal to the surface 27. The body 12 has a base 23 and a free end15 coaxial with the axis X9. The body 12 is connected to the surface 27by the base 23. The end 15 is distant from the surface 27. The base 23is of larger diameter or size than the free end 15. The tubular body 12and/or the surface 27 may be porous for osseous colonization thereof,for securing the prosthesis 1 to the scapula 5.

Preferably, the glenoid component 3 also comprises a tubular body 21protruding from the articular side 20, coaxially and opposite to thebody 12.

In the present example, the engaging member 9 comprises a screw 13,configured for engaging the scapula 5. This screw 13 is inserted throughthe main body 22, from side 20 to side 7. For the present example, thescrew 13 is introduced through the tubular body 21. The screw 13 isfurther introduced coaxially through the tubular body 12, so that asharp end 14 of the screw 13 protrudes from a free end 15 of the tubularbody 12. A head of the screw 13, not visible on the figures, opposite tothe sharp end 14, lays inside the tubular body 21. The prosthesis 1 maybe secured to the scapula 5 by engagement of the screw into the scapula5.

Depending on the application, tubular body 21 may be omitted. In thiscase, if the abovementioned screw 13 is provided, it is inserted throughthe tubular body 12 from the surface of side 22.

Depending on the application, the engaging member 9 may comprise onlyone among the screw 13 and the tubular body 12.

Any other suitable engaging member 9 may be chosen instead of theengaging member 9 described above, depending on the application.

The coupling member 204 of the augment insert 200 is configured forsecuring to the engaging member 9 at the scapular side 7 of the glenoidcomponent 3. For this purpose, the coupling member 204 is provided atthe radial edge portion 211. More precisely, the coupling member 204 isprovided at a median location of the radial edge portion 211. Thus theaugment insert 200 is secured to the glenoid component 3 at a centrallocation of side 7, so that the fixation is especially stable.

Alternatively, the coupling member 204 may be provided at anotherlocation of the edge 210 of the augment insert 200, for securing theaugment insert 200 to an engaging member of the glenoid component 3which is located at a lateral location of the scapular side thereof.Otherwise, the engaging member 9 can be provided at another location ofside 7, the location of the coupling member 204 being modifiedaccordingly. In particular, the coupling member 204 can be provided at acentral or lateral location of the side 206 or through the body 202. Forany embodiment, the coupling member 204 is attached to the body 202,preferably fixedly.

In the example illustrated on FIGS. 1 to 11, the coupling member 204comprises a ring coaxial with an axis X204 of the augment insert 200.Said axis X204 is substantially orthogonal, or slightly inclined,relative to the surfaces of sides 206 and 208. Said axis X204 ispositioned out of the peripheral edge 210. The ring of the couplingmember 204 is configured to be connected to the tubular body 12 forsecuring the augment insert 200 to the body 12.

In the present example, the ring comprises two resilient arm portions221 and 222 of circular shape, so that the ring may be snapped onto thebody 12. Alternatively, the coupling member 204 comprises a continuousring that may be snap-fitted onto the body 12. Alternatively, thecoupling member 204 comprises a continuous ring that may be tight-fittedor friction fit onto the body 12. The ring of the coupling member 204may form a frustoconical sleeve for conical fitting onto thefrustoconical body 12.

The presence of the coupling member 204 provides a particularly highstability to the augment insert 200 when the prosthesis 1 is implementedin the body of the patient, thereby preventing any relative movement ofthe augment insert 200 and the glenoid component 3. In addition, it ispossible to manipulate the prosthesis 1 while the augment insert 200 isin a configuration secured onto the glenoid component 3, so that theaugment insert 200 remains adequately positioned onto the glenoidcomponent 3 during manipulation of the prosthesis 1.

In the illustrated example, most of the body 12 and the screw 13 of themember 9 extends beyond the side 208, by passing through the couplingmember 204, as visible on FIGS. 3 and 4. Thus, both body 12 and screw 13may be used for providing fixation of the prosthesis 1 to the scapula 5.

Turning to the engaging members 8 and 10, said members 8 and 10 arerespectively coaxial with an axis X8 and an axis X10 of the glenoidcomponent 3. The axis X8, X9 and X10, as for their respective members 8,9 and 10, may extend side by side in parallel orientations, oroptionally in diverging or converging directions for a more reliablefixation of the prosthesis 1 into the scapula 5. In the present example,the engaging members 8 and 10 are provided at either side of theengaging member 9. In other words, while the engaging member 9 is at acentral location of the side 7, the engaging members 8 and 10 are at alateral location thereof. Preferably, the engaging members 8, 9 and 10are arranged along a same line of the side 7, preferably a diametricline.

In the present example, the glenoid component 3 comprises twothrough-holes 16 and 17, coaxial respectively with the axis X8 and X10.The through-holes 16 and 17 are provided through the body 22, from side20 to side 7. In the present example, the engaging members 8 and 10 bothcomprise a screw, coaxial respectively with the axis X8 and the axis X10and accommodated through the holes 16 and 17 respectively. A sharp endof each screw is pointed in a direction similar than the sharp end 14 ofthe screw 13. Thus, the screws 16 and 17 may engage the scapula 5 of thepatient, thereby securing the prosthesis 1 to said scapula 5. Any othersuitable embodiment of engaging members 8 and 10 may be provided insteadof screws.

In the present example, the augment insert 200 comprises two distinctcut-away portions 219 and 220, for accommodating respectively theengaging members 8 and 10, so that said members 8 and 10 may extendbeyond the side 208 of the augment insert 200. In the present example,each cut-away portion 219 and 220 is provided at the radial edge portion211. The cut-away portions 219 and 220 are located on either side of thecoupling member 204. One or both of the cut-away portions 219 and 220may have an anti-rotation function for the fixation of the augmentinsert 200 relative to the glenoid component 3 around axis X9, byrespective cooperation with one or both of the engaging members 8 and10. For this purpose, the shape of the cut-away portions 219 and/or 220may be chosen as corresponding to the shape of their respective member 8and/or 10. In the present example, each cut-away portion 219 and 220 isof semi-circular or concave shape. In the present example, as visible onFIG. 3, when the augment insert 200 is secured to the glenoid component3, the concave surface of the cut-away portion 220 is aligned with thecircular surface of the through-hole 17 so that the cut-away portion 220may bear against the engaging member 10.

The same pattern may optionally be applied for cut-away portion 219 andthrough-hole 16. Preferably, only one of the cut-away portions 219 and220 bears against a lateral engaging member of the glenoid component 3.

Depending on the number and the location of the engaging membersprovided at the covered part of the scapular side of the glenoidcomponent 3, less or more cut-away cut-away portions may be provided foraccommodating said engaging members. Also, through-openings of similarfunction may be provided from side 206 to side 208, inside theperipheral edge 210, depending on the number and location of engagingmembers of the glenoid component.

Instead of two lateral engaging members 8 and 10, no lateral engagingmember, one lateral engaging member or more lateral engaging members maybe provided on the scapular side of the glenoid component 3.Through-openings or cut-away portions may be provided on the augmentinsert 200 accordingly.

For any embodiment considered, it is preferred at least one of theengaging members 8, 9 and/or 10 extends beyond side 208, of the augmentinsert 200 when the augment insert 200 is secured to the glenoidcomponent 3. It can be provided that only one of the engaging membersextends beyond side 208. Thus, the concerned engaging member can beengaged into the scapula 5 for fixation of the prosthesis 1.

In the present example, the body 22 comprises of two parts made of adifferent material, a scapular part extending from the scapular side 7and an articular part extending from the articular side 20. The scapularpart and articular part are fixed to each other at a medial plane of thebody 22 located between the sides 7 and 22, substantially perpendicularto the axis X9. For example, the articular part is metallic, while thescapular part is made of a thermoplastic such as polyethylene. In anembodiment, the scapular part may have a lattice structure while thearticular part has a solid structure. In the present example, thetubular body 12 has an outer surface, for engaging the scapula 5, whichis integral with the scapular part. In the present example, the tubularbody 12 has an inner surface which is integral with the articular part.Alternatively, the tubular body 12 may be integral with one part or theother or both. In the present example, the tubular body 21 is integralwith the articular part, although it may be integral with the scapularpart or both parts.

Alternatively, the body 22 may be made of a single integral part of onematerial.

As illustrated in dashed line on FIG. 1, the glenoid component 3 maycomprise a glenosphere 24 fixed to the articular side 20. Theglenosphere 24 is omitted from the FIGS. 2 to 5. For example, theglenosphere 24 is fixed to the body 22 by means of the engaging members8 and 10. Alternatively, the glenosphere 24 is fixed to the tubular body21. For this purpose, the tubular body 21 may be provided with an outeror inner thread for screwing the glenosphere 24 onto the tubular body21. The glenosphere 24 forms a convex articular component with a convexarticular surface. By “convex”, it is meant a protruding surface,preferably of spherical shape, configured for cooperating with anon-illustrated corresponding concave articular surface. By “concave”,it is meant that the surface is in the shape of a socket, preferablyspherical. The glenosphere 24 is configured to cooperate with a concavearticular surface provided at a humeral head of the patient in relationwith the scapula 5. Said concave articular surface is preferablyprovided on an artificial humeral head belonging to the prosthesis 1.The concave and the convex articular surfaces together form theartificial joint for the patient, around which the humerus of thepatient and the scapula 5 are articulated. The glenoid component 3having such a glenosphere 24, the prosthesis 1 and the glenoid component3 may be qualified of “reverse”.

The geometric center of the glenosphere 24 is preferably centered on theaxis X9.

Instead of being a separate part fixed onto the body 22, the glenosphere24 may be integral with the body 22.

Any other suitable convex articular component than the glenosphere 24may be implemented for the glenoid component 3. Instead of a convexarticular component, a concave articular component including a concavearticular surface may be implemented for the glenoid component 3, forarticulation with a convex humeral head. In this case, the glenoidcomponent 3 and the prosthesis may be qualified of “anatomic”.

Turning to FIGS. 5 to 10, the prosthesis 101 comprises the glenoidcomponent 103 and the same augment insert 200 as described above.

The glenoid component 103 comprises a main body 122, including theabovementioned scapular side 107 and an opposed articular side 120.

As visible on FIG. 7, the scapular side 107 comprises a slightly curvedscapular surface 127, which shape or geometry corresponds to the side206 of the augment insert 200. Also, the surface 127 is preferably ofsimilar shape than the surface 27 of the scapular side 7 of the glenoidcomponent 3. More specifically, the surface 127 is designed to becompletely, or at least in majority, in contact with the surface of theside 206, when the augment insert 200 is secured to the glenoidcomponent 3. This enables the side 206 to bear against side 107.

The scapular side 107 of the glenoid component 103 has a peripheral edge104 delimiting the surface 127. The edge 104 preferably has a similarshape than the edge 4 of the glenoid component 3. As visible on FIGS. 8and 9, the labrum edge portion 212 and a portion of the edge 104 are putin correspondence when the insert 200 is secured to the glenoidcomponent 3. In other words, the labrum edge portion 212 matches withthe edge 104 along a portion thereof. More visibly on FIG. 9, therespective peripheral surfaces of the labrum edge portion 212 and of theedge 104 are arranged continuously when the insert 200 is secured to theglenoid component 103.

More generally, the peripheral edge 104 has a generally elliptic shapecorresponding to the shape of the rim of the glenoid cavity of thescapula 105 of the patient.

When the augment insert 200 is secured to the glenoid component 103,only a portion of the surface 127 is covered by said augment insert 200,similarly to the surface 27. Thus, a portion of the surface 127 remainsuncovered and may bear against glenoid cavity of the scapula 105 of thepatient, when the shoulder prosthesis 101 is implemented in the patient.In the present example, the portion of the scapular side 107 covered bythe augment insert 200 is also a posterior portion of the scapular side107, while the anterior portion is left uncovered. Thus, a posteriorlevelling correction is applied.

As visible on FIGS. 6 to 10, the scapular side 107 of the glenoidcomponent 103 comprises four engaging members 108, 109, 110 and 111,protruding from the scapular surface 127.

The engaging member 109 is protruding from a central location of thescapular surface 127.

In the present example, said member 109 comprises a stem 112 ofessentially cylindrical shape, protruding from the surface 127 along anaxis X109. The axis X109 is generally orthogonal to the surface 127. Thestem 112 has a base 123 and a free end 115 coaxial with the axis X109.The stem 112 is connected to the surface 127 by the base 123. The end115 is distant from the surface 127. The stem 112 and/or the surface 127may be porous for osseous colonization thereof, for securing theprosthesis 101 to the scapula 105. Alternatively, the stem 112 may beprovided with wings, fins or any other suitable anchoring element forimplantation into the scapula 105. The prosthesis 101 may be secured tothe scapula 105 by engagement of the stem 112 into the scapula 5.Preferably, no screw is provided along axis X109 for fixation of theprosthesis 101 into the scapula 105.

Depending on the application, a different type of engaging member(s) maybe provided as the engaging member 109. In particular, engaging member109 may be of the same type than, or may be identical to, the engagingmember 9.

The coupling member 204 of the augment insert 200, otherwise configuredfor securing to the engaging member 9 of the glenoid component 3, isalso configured for securing to the engaging member 109 of the glenoidcomponent 103.

For this purpose, the location of the engaging member 109 on thescapular side 107 is preferably similar to the location of the engagingmember 9 for the scapular side 7, should this location be central ornot.

For this purpose, it is provided in the present example that the outerdiameter or dimensions of the stem 112 is adapted for snap-fitting ofthe arms portions 221 and 222 of the coupling member 204, when the side206 of the augment insert 200 is brought into contact of the surface127.

Thus the coupling member 204 may indifferently be secured onto:

-   -   the engaging member 9, for fixation of the augment insert 200 to        the glenoid component 3, when the side 206 bears against the        side 7 of the glenoid component 3, or    -   the engaging member 109, for fixation of the augment insert 200        to the glenoid component 103, when the side 206 bears against        the side 107 of the glenoid component 103.

More specifically, it may be provided that at least a portion of theouter peripheral surface of the engaging member 9 and of the engagingmember 109, configured for securing the coupling member 204, has asimilar geometry or at least a compatible shape with the coupling member204.

If a coupling member of different type than the coupling member 204 ischosen, the engaging member 109 may be adapted accordingly, andvice-versa.

As for member 9, the member 109 is configured to extend beyond the side208 by passing through the coupling member 204, as visible on FIGS. 8and 9.

Turning to the engaging members 108, 110 and 111, said members 108, 110and 111 are respectively coaxial with an axis X108, an axis X110 and anaxis X111 of the glenoid component 103. The axis X108, X109, X110 andX111, as for their respective members 108, 109, 110 and 111, may extendside by side in parallel orientations, or optionally in diverging orconverging directions for a more reliable fixation of the prosthesis 101into the scapula 105. In the present example, the engaging members 108,110 and 111 are distributed around the engaging member 109. In otherwords, while the engaging member 109 is at a central location of theside 107, the engaging members 108, 110 and 111 are at a laterallocation thereof. Preferably, the lateral engaging members 108, 109 and111 are arranged in a triangle comprising the central engaging member110.

In the present example, each lateral engaging member 108, 109 and 111comprises a stem coaxial with the concerned axis X108, X109 or X111,preferably of similar features than the stem 112. The stems of themembers 108, 109 and 111 are preferably of smaller diameter and lengththan the stem 112. Any other suitable embodiment of engaging members108, 109 and 111 may be provided instead of stems.

One or both of the two cut-away cut-away portions 219 and 220 may beconfigured for accommodating at least one or more of the lateralengaging members of the glenoid component 103, indifferently from thelateral engaging members of the glenoid component 3.

The engaging member 110 being located at an uncovered part of the side107, said member 110 extends beyond the side 208 without passing throughthe augment insert 200. The member 110 extends outside the peripheraledge 210.

One or more further engaging members similar to member 110 mayadditionally be provided.

In the present example, the engaging member 108 is accommodated into thecut-away portion 219 while no engaging member is accommodated in thecut-away portion 220, as visible on FIGS. 7 to 9. Thus, one of thecut-away portions 219 and 220 is provided for accommodation of one ofthe engaging members of the glenoid component 3, while the other isprovided for accommodation of one of the engaging members of the glenoidcomponent 103, ensuring that an anti-rotation function is obtainedregardless the augment insert 200 being secured to the glenoid component3 or 103. Only one of the cut-away portions 219 and 220 used at a timewhen the augment insert 200 is mounted on one of the glenoid components3 or 103, while the other cut-away portion 219 or 220 is not used.

The glenoid components 3 and 103 respectively have scapular sides 7 and107 that are shaped differently, since they include respectivelyengaging members 8, 9 and 10 and engaging members 108, 109, 110 and 111.As defined above, the location, shape and number of engaging membersdiffer for the glenoid components 3 and 103: they constitute differencesof shape for the respective scapular sides 7 and 107 of the glenoidcomponents 3 and 103.

In the present example, the sides 7 and 107 are shaped differentlyalthough the surfaces 27 and 127 have a similar shape. Alternatively,the surfaces 27 and 127 may also be of different shape, adding to theshape differences of sides 7 and 107. In a non-illustrated embodiment,scapular sides of different shape may be obtained for two glenoidcomponents if the scapular surfaces are of different shape, even if theengaging member are at similar locations and/or are of the same number.Any other material element provided on one of the scapular surfaces maygenerate a difference of shape of the respective scapular sides. Inother words, the shape differences described above correspond togeometry differences of the sides 7 and 107, including scapular surfaceand engaging members.

These shape differences may make an augment insert shape-compatible witha first glenoid component and at the same time shape-incompatible with asecond glenoid component with a scapular side of different shape thanthe first glenoid component, since the augment insert would match thescapular side of the first glenoid component and not match the scapularside of the second glenoid component. When shape-compatible, the augmentinsert can be secured to the glenoid component. When shape-incompatible,the augment insert cannot properly be secured to the glenoid component.By “shape-compatible”, it is understood that the two pieces have amatching shape and can be assembled. By “shape-incompatible”, it isunderstood that the two pieces do not have a matching shape and cannotbe assembled as a consequence of this shape incompatibility.

In the present example, the abovementioned cut-away portions 219 and 220enable the augment insert 200 to be shape compatible with both glenoidcomponents 3, thanks to the cut-away portion 220, and glenoid component103, thanks to the cut-away portion 219.

As best visible on FIG. 6, the body 202 of the augment insert 200comprises a breakable portion 230 configured to be broken off the body202 for making the augment insert 200 shape-compatible with the glenoidcomponent 3 and/or with the glenoid component 103. In other words, thebreakable portion 230 may be detached and removed from the body 202 bysplitting a portion from said body 202.

The breakable portion 230 is a part of the body 202 and extends from thesurface of side 206 to the surface of side 208, in other wordsthroughout the body 202. In other embodiments, the breakable portion maybe interior to any peripheral edges.

When the breakable portion 230 is broken off the body 202, an aperture234 is opened through the body 202, as shown on detail VI of FIG. 6.This aperture 234 extends from the side 206 to the side 208, in otherwords is formed throughout the body 202. The aperture 234 has a similarshape than the broken off breakable portion 230.

The breakable portion 230 is configured to be manually breakable, orpreferably breakable with a non-powered hand-held ancillary, notillustrated. A powered hand-held ancillary may be used instead. By“ancillary”, it may be understood “surgical instrument”. Alternatively,the breakable portion 230 may be configured not to be manually breakableand to require a non-powered hand-held ancillary or a powered hand-heldancillary, for safety reasons, or for more reliable fixation of thebreakable portion 230 should the augment insert 200 be used with thebreakable portion 230 left unbroken.

Preferably, the body 202 comprises a pre-cut outline 232 providedthroughout the body 202 from the side 206 to the side 208. The pre-cutoutline 232 enables manual break-off, or break-off with theaforementioned ancillary. The pre-cut outline 232 delimits the breakableportion 230 when said breakable portion 230 is not broken. The pre-cutoutline 232 forms an aperture edge 236 of the aperture 234 when thebreakable portion 230 is broken off the body 202.

Other means than the pre-cut outline 232 of the present example may beprovided for securing in a breakable manner the breakable portion 230 tothe body 202, and may include one or more of the following elementsprovided in the body 202: breakable leg, fracture initiation zone, notchor portion of lesser thickness.

In the present example, the breakable portion 230 is essentially shapedas a disc, or more precisely as a portion of disc. Thus, the pre-cutoutline 232 is shaped as a circle, or a portion of circle. In general,the pre-cut outline 232 extends around the periphery of the breakableportion 230. More generally, the aperture 234 provides free space foraccommodating the engaging member 110 of the glenoid component 103, sothat said engaging member 111 may extend through the augment insert 200.Consequently, any shape may be chosen for the breakable portion 230 andfor the aperture 234 as long as it allows the engaging member 111 topass through the body 202 so that it can engage the scapula. Preferably,the shape of the breakable portion 230 and of the aperture 234 is chosento correspond to, or even to coincide with, the shape of the outerperipheral surface of the engaging member 111.

As a consequence, the augment insert 200 may be secured to the glenoidcomponent 103 only if the breakable portion 230 has been broken off. Inother words, if the breakable portion 230 is broken off, the augmentinsert 200 becomes shape-compatible with the glenoid component 103,since the augment insert 200 can be correctly secured to the glenoidcomponent 103, namely in the orientation and position defined above,including the engaging member 111 accommodated through the aperture 234.“Correctly secured” is illustrated on FIGS. 3, 4, 8 and 9, and includesthat the side 206 bears against the scapular side of the concernedglenoid component and that the coupling member 204 is secured to theengaging member as described above. If the breakable portion 230 is notbroken off, the augment insert 200 is shape-incompatible with theglenoid component 103, namely cannot be correctly secured to the glenoidcomponent 103. The reason is that the engaging member 111 mechanicallyopposes securing the augment insert 200, which has an incorrect,non-corresponding shape.

The breakable portion 230 may be configured to be broken off by manuallypressing said portion 230 onto the engaging member 111.

When the augment insert 200 is assembled onto the side 107, the aperture234 is coaxial with the axis X111.

In the present example, the location of the engaging member 111 on theside 107 imposes that the breakable portion 230 is provided at theradial edge portion 211. In other words, the breakable portion 230extends from the radial edge portion 211. More precisely, in the presentcase, the breakable portion 230 is provided at the cut-away portion 220,namely extends from the cut-away portion 220. When the breakable portion230 is not broken off, a part of the outline of the cut-away portion 220is formed by the breakable portion 230.

Depending on the location of the engaging member 111 relative to theside 107, the location of the breakable portion 230 on the body 202 maybe modified accordingly. For example, the breakable portion 230 may beprovided in a more central location of the body 202, namely inside theperipheral edge 210. The breakable portion 230 may alternatively beprovided at the labrum edge portion 212. Locating the breakable portion230 at the peripheral edge 210 enables an easier manual breaking off, orwith the aforementioned ancillary.

Should the breakable portion 230 be broken-off or not, the augmentinsert 200 of the present example is shape-compatible with the scapularside 7 of the glenoid component 3. However, it is preferred that thebreakable portion 230 is not broken off when the augment insert 200 issecured to the glenoid component 3, for a better mechanical stability ofthe augment insert 200, for a better behavior and/or resistance of thebody 202 and advantageously for ensuring a reliable anti-rotationfunction of the cut-away portion 220, said cut-away portion 220 beingfully delimited when the portion 230 is not broken off.

For the augment insert 200 to be shape-compatible with the glenoidcomponent 3 with the breakable portion 230 left unbroken, the breakableportion 230 preferably has a surface 238, which extends at the side 206of the body 202, when the breakable portion 230 is not broken off, andwhich is shaped to match the surface 27 of the glenoid component 3 whenthe side 206 bears against said scapular side 7. In other words, thesurface 238 extends continuously to the surface of the side 206.

A surface 240 of the breakable portion 230 at the side 208, namelyopposed to the surface 238, preferably extends continuously with thesurface of the body 202 on side 208. As a result, when the breakableportion 230 is not broken, side 208 may regularly bear against thescapula 5.

Depending on the number and the location of the engaging members of theglenoid components 3 and 103, or if other shape differences exist forthe respective scapular sides of the glenoid components, more than onebreakable portion similar to the breakable portion 230 may be providedfor the body 202 accordingly.

As visible on FIGS. 6, 9 and 10, the articular side 120 of the glenoidcomponent 103 may comprise a concave articular surface 124, formedintegral with the body 122. The surface 124 is configured to cooperatewith a convex articular surface provided at a humeral head of thepatient in relation with the scapula 105. The surface 124 is preferablyof spherical shape, but may have any other suitable convex shape. Saidconvex articular surface is preferably provided on an artificial humeralhead belonging to the prosthesis 101. The concave and the convexarticular surfaces together form an artificial joint for the patient,around which the humerus of the patient and the scapula 105 arearticulated. The glenoid component 103 having such a concave articularsurface 124, the prosthesis 101 and the glenoid component 103 may bequalified of “anatomic”.

The geometric center of the concave articular surface 124 is preferablycentered on the axis X109.

Instead of being integral with the body 122, the surface 124 may beprovided on a part separate from the body 122 and assembled therewith.Instead of a concave articular surface, a convex articular surface maybe provided

In the present example, the body 122 is made of a single part.Preferably, the body 122 is integral with the engaging members 108, 109,110 and 111. Alternatively, the body 122 may be made of a plurality ofparts of different materials. In this case, the engaging members 108,109, 110 and 111 may be made of a different material than all or part ofthe body 122.

The glenoid component 103 is preferably made of a thermoplastic materialsuch as polyethylene. Any other suitable material, such as a metallicmaterial, may be used instead. In an embodiment, at least a part of theglenoid component 103 including the engaging members 108, 109, 110 and111 and the scapular side 107 may have a lattice structure.

The prosthesis 1 and/or 101 may be provided as a kit, including:

-   -   the augment insert 200, with the breakable portion 230 left        unbroken,    -   optionally augment inserts with similar features than the        augment insert 200, but with a body of different shape, for        example of different thickness or providing a different coverage        of the scapular side, such as an augment insert 300 described        below,    -   preferably one or both of the glenoid component 3 and 103,    -   optionally a humeral head component, and    -   optionally one or more hand-held ancillary for breaking off the        breakable portion 230.

A kit may be provided for a left prosthesis, or for a right prosthesis,or including both prosthesis.

Turning now to FIGS. 12 and 13, the glenoid component 103 is illustratedwith another embodiment of an augment insert 300, illustrated alone onFIG. 14. The glenoid component 103 and the augment insert 300 belong toa prosthesis 301.

The augment insert 300 has similar features than the augment insert 200,designated with the same terms and/or indicated with similar referencesigns augmented of 100. The main differences between the augment insert300 and augment insert 200 are explicitly described below.

The augment insert 300 mainly comprises a body 302 and a coupling member304. The body 302 has two opposed sides 306 and 308, a peripheral edge310 with a radial edge portion 311 and a labrum edge portion 312,cut-away portions 319 and 320 and a breakable portion 330.

The body 302 differs of the body 202 in that said body 302 is shaped tocover a different portion of the scapular side 7 and 107 when theaugment insert 300 is secured to the corresponding glenoid component 3or 103. More precisely, an anterior portion of side 7 or 107 is covered,while a posterior portion of side 7 or 107 is left uncovered. Also, thebody 302 covers a portion of smaller area than the body 202, since thebody 302 has smaller dimensions. The labrum edge portion 312, alike thelabrum edge portion 212, is put in correspondence with a portion of theedge 4 and 104 when the insert 300 is secured respectively to theglenoid component 3 and 103.

Since the body 302 covers a different portion of the scapular sides 7and 107, the cut-away portion 319 is left free when the augment insert300 is secured to the glenoid component 3 and accommodates the engagingmember 108 when secured to the glenoid component 103, as best visible onFIG. 13. The cut-away portion 320 accommodates engaging member 10 whenthe augment insert 300 is secured to the glenoid component 3 and thebreakable portion 330 is left unbroken. When the augment insert 300 issecured to the glenoid component 103, the breakable portion is brokenoff and an aperture 336 opened by said braking off accommodates theengaging member 110, as may be best seen on FIG. 13.

Although the described examples apply to human patients, the inventionmay also be implemented for animal patients.

The invention claimed is:
 1. A method of using an augment insert forforming a shoulder prosthesis, wherein the augment insert comprises: acoupling member for securing the augment insert to a glenoid componentof a shoulder prosthesis, and a body comprising a first side, a secondside opposite the first side, and at least one breakable portionconfigured to be broken off the body, wherein when the breakable portionis broken off the body, an aperture is opened through the body, whereinthe method comprises the following steps: Step A): choosing if theaugment insert should be secured to: choice A1): a first glenoidcomponent comprising a first scapular side, or choice A2): a secondglenoid component comprising a second scapular side; if choice A1) ischosen at Step A): Step B1): not breaking off the breakable portion, andStep C1): securing the first side of the augment insert to the firstscapular side of the first glenoid component with the coupling member ofthe augment insert such that the shoulder prosthesis comprises the firstglenoid component and the augment insert; if choice A2) is chosen duringat Step A): Step B2): breaking off the breakable portion, and Step C2):securing the first side of the augment insert to the second scapularside of the second glenoid component with the coupling member of theaugment insert such that the shoulder prosthesis comprises the secondglenoid component and the augment insert.
 2. The method according toclaim 1, wherein: Steps A), B1) and C1), or steps A), B2) and C2), areperformed intraoperatively; and Step A) is performed depending on thespecific shoulder pathology of the patient.
 3. The method according toclaim 1, wherein the method further comprises a step D), performed aftersteps A) and after either steps B1) and C1) or steps B2) and C2),comprising implanting the shoulder prosthesis in the patient, bysecuring said shoulder prosthesis to the scapula of the patient.
 4. Themethod according to claim 3, wherein the shoulder prosthesis comprisesengaging members; step D) comprises engaging the engaging members intothe scapula of the patient for securing the shoulder prosthesis to thescapula of the patient, so that: the augment insert is interposedbetween the scapula of the patient and the chosen first or secondglenoid component of the shoulder prosthesis; and the second side of theaugment insert bears against the scapula of the patient or is at leastadjacent thereto.
 5. The method according to claim 1, wherein the methodfurther comprises the following steps, if choice A1) is chosen at stepA) and after steps B1) and C1) are performed: Step F): separating theaugment insert from the first glenoid component, Step B2), and Step C2).6. The method according to claim 1, wherein the method further comprisesadvancing a first engaging member through the aperture to secure theshoulder prosthesis including the second glenoid component to thescapula of the patient if choice A2 is chosen during step A).
 7. Themethod according to claim 1, wherein the body comprises a pre-cutoutline, the pre-cut outline delimiting the breakable portion, andforming an aperture edge of the aperture when the breakable portion isbroken off the body.
 8. The method according to claim 1, wherein: thebody comprises a peripheral edge delimiting the first side and thesecond side, the peripheral edge comprises a thinner radial edge portionand a thicker labrum edge portion, and the breakable portion is providedat the radial edge portion.
 9. The method according to claim 1, wherein:the first glenoid component comprises an articular side opposed to thescapular side and comprising a convex articular surface, and the secondglenoid component comprises an articular side opposed to the scapularside and comprising a concave articular surface.
 10. A method of usingan augment insert for forming a shoulder prosthesis, the methodcomprising: positioning a first side of a body of an augment insertadjacent to a scapular side of a glenoid component, the augment insertcomprising a coupling member, the glenoid component comprising a firstengaging member and a second engaging member spaced apart from the firstengaging member; breaking off a portion of the augment insert disposedat a position corresponding to the second engaging member such that anaperture is provided from the first side of the body of the augmentinsert to a second side of the body of the augment insert; securing thecoupling member to the first engaging member of the glenoid componentsuch that the first side of the body of the augment insert is disposedon the scapular side of the glenoid component and the second engagingmember is disposed through the aperture provided by breaking off theportion of the augment insert; advancing the first and second engagingmembers into a bone surface at or adjacent to a glenoid of a patientuntil the second side of the body of the augment insert is adjacent toor on the bone surface.
 11. The method of claim 10, wherein breaking offthe portion of the augment insert comprises breaking off the portionalong a pre-cut outline disposed at least partially around a part of thebody to be removed.
 12. The method of claim 10, wherein breaking off theportion of the augment insert comprises manually breaking off theportion.
 13. The method of claim 10, wherein breaking off the portion ofthe augment insert comprises disengaging the portion of the augmentinsert from a leg, notch, portion of lesser thickness, or fractureinitiation zone in the body of the augment insert.
 14. The method ofclaim 10, further comprising breaking off a second portion of theaugment insert disposed at a position corresponding to a third engagingmember of the glenoid component spaced apart from the first and secondengaging members of the glenoid component.
 15. A method of using anaugment insert for forming a shoulder prosthesis, the method comprising:positioning a first side of a body of an augment insert adjacent to ascapular side of a glenoid component comprising an engaging member, theaugment insert comprising a coupling member and a breakable portion;securing the coupling member to the engaging member of the glenoidcomponent such that the first side of the body of the augment insert isdisposed on the scapular side of the glenoid component; advancing theengaging member into a bone surface at or adjacent to a glenoid of apatient until a second side of the body of the augment insert includingthe breakable portion is adjacent to or on the bone surface.
 16. Themethod of claim 15, wherein the glenoid component comprises a centralengaging member and an expanse on the scapular side of the glenoidcomponent free of integral engaging members.
 17. The method of claim 16,wherein the glenoid component further comprises one or morethrough-holes disposed in the expanse and further comprising advancing ascrew through at least one of the one or more through-holes and along aportion of the body of the augment insert.
 18. The method of claim 17,wherein the screw(s) are advanced along a concave edge of the augmentinsert.
 19. The method of claim 18, wherein the concave edge comprises aradial edge portion of the augment insert.
 20. The method of claim 18,wherein the concave edge is distinct from the breakable portion.